Stop Loss Training Lead

Personify Health; United States; Remote; USD 65,000 - 73,000; Full time

Benefits offered by this job

Competitive salary

Benefits from day one

Unlimited PTO

Medical and dental coverage

Mental health support

Retirement planning

Professional development

Job summary

Personify Health, Inc. is seeking a Stop Loss Lead to serve as the department's technical authority, ensuring accurate reimbursements and contract interpretation.

You will audit submissions, train the team, and drive improvements that accelerate timely reimbursements for self-funded plans. In this role, you will review contracts, manage reimbursements end-to-end, and partner with leadership on action-oriented fixes.

Qualifications

• High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred
• 3-5 years of experience in stop loss, self-funded health plan administration, claims, or related healthcare required
• Advanced claims processing and reimbursement experience strongly preferred
• Experience interpreting stop loss contracts and plan documents preferred
• Experience conducting audits, quality reviews, or process improvement initiatives preferred
• Experience training or mentoring team members preferred
• Advanced knowledge of stop loss administration, reimbursement processes, and contract interpretation
• Working knowledge of medical terminology and CPT, HCPCS, and ICD-10 coding (preferred)
• Proficiency in Microsoft Excel, Word, Outlook, and reporting tools
• Auditing and data analysis skills, including identifying trends and building data-driven recommendations

Responsibilities

• Serve as the stop loss authority on administration, reimbursement, and contract interpretation
• Review stop loss contracts, plan documents, and carrier requirements in depth to ensure compliance and capture every reimbursement opportunity available
• Support submission, tracking, and reconciliation of stop loss claims, and manage aging items, carrier inquiries, disputes, and escalated cases through to closure
• Conduct regular reviews of claim submissions, reimbursement tracking, documentation, and correspondence to confirm accuracy and report results to leadership
• Spot recurring errors, trends, and process gaps in audit results and propose corrective action with leadership
• Onboard new Stop Loss Specialists, create and maintain training materials and SOPs, and deliver coaching sessions
• Evaluate workflows, lead process improvement initiatives, and roll out new tools and best practices, including testing system updates
• Review and help prepare monthly stop loss and reimbursement reporting and support audits

Skills

Stop loss administration

Advanced claims processing

Auditing & data analysis

Contract interpretation

Data analysis

Education

High School Diploma

Associate/Bachelor's degree preferred

Tools

Microsoft Excel

Microsoft Word

Outlook

Job description

Overview

Who We Are

Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

Learn even more about the work that drives us at personifyhealth.com.

Responsibilities

Ready to be the go-to expert who turns stop loss complexity into reimbursement wins?

Why This Role Matters

Every self-funded plan we serve depends on getting stop loss right, and that starts with someone who knows the contracts inside and out. As Stop Loss Lead, you’re the department’s technical authority, the person who makes sure eligible reimbursements get submitted, tracked, and collected instead of left on the table. Your audits catch problems early, your training makes the whole team sharper, and your process improvements make every claim move faster and cleaner. The stronger your expertise and the quality of your work, the stronger our reimbursement outcomes, our client relationships, and the department as a whole.

What You’ll Actually Do

• Serve as the stop loss authority: Act as the department’s subject matter expert on administration, reimbursement, and contract interpretation, giving the team a trusted source for answers on complex questions.
• Dig into contracts and carrier requirements: Review stop loss contracts, plan documents, and carrier requirements in depth to ensure compliance and capture every reimbursement opportunity available.
• Drive reimbursements to resolution: Support the submission, tracking, and reconciliation of stop loss claims, and work aging items, carrier inquiries, disputes, and escalated cases through to closure.
• Audit for quality: Conduct regular reviews of claim submissions, reimbursement tracking, documentation, and correspondence to confirm accuracy and completeness, then report results and performance metrics to leadership.
• Turn findings into fixes: Spot recurring errors, trends, and process gaps in audit results, develop corrective action recommendations, and partner with leadership to put them in place.
• Build and coach the team: Onboard new Stop Loss Specialists, create and maintain training materials and standard operating procedures, and deliver coaching and refresher sessions that close knowledge gaps.
• Improve how we work: Evaluate workflows, lead or support process improvement initiatives, and help roll out new tools and best practices, including testing and validating system updates.
• Own reporting and audit readiness: Review and help prepare monthly stop loss and reimbursement reporting and carrier submissions, support internal and external audit requests, and keep documentation accurate and current.
• Step in where it counts: Process stop loss claims and handle related operational work when workflow demands require it, and contribute to special projects that advance department goals.

Qualifications

What You Bring to Our Team

Education & Experience:

• High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred
• 3-5 years of experience in stop loss, self-funded health plan administration, claims, or related healthcare required
• Advanced claims processing and reimbursement experience strongly preferred
• Experience interpreting stop loss contracts and plan documents preferred
• Experience conducting audits, quality reviews, or process improvement initiatives preferred
• Experience training or mentoring team members preferred

Technical Skills:

• Advanced knowledge of stop loss administration, reimbursement processes, and contract interpretation
• Working knowledge of medical terminology and CPT, HCPCS, and ICD-10 coding (preferred)
• Proficiency in Microsoft Excel, Word, Outlook, and reporting tools
• Auditing and data analysis skills, including identifying trends and building data-driven recommendations

Benefits

The Highlights:

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions (yes, we use what we build)
• Unlimited PTO—rest and recharge time is non-negotiable
• Mental health support, retirement planning, and financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health

Want the full picture?Visitpersonifyhealthbenefits.comto explore our complete benefits package, wellness programs, and other employee perks.

Compensation: This position offers a base salary range of $65,000 - $73,000, depending on location, skills, and experience. You're eligible for our full benefits package starting day one.

Our Commitment:Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.

Stay Safe:Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them [e-mail]. View all legitimate openings atpersonifyhealth.com/careers.